News Medical Malpractice

On May 7, 2001, my mother, Eileen Bialek {age 72} underwent elective surgery for correction of a prolapsed uterus and cystocle. The surgeon in the department of Urology at a major medical facility in Cleveland agreed to perform an open laparotomy with a uterine suspension. Eileen’s past medical history included colon resection for bowel cancer 18 years prior. The surgeon was aware that she had previous abdominal surgery but decided that open laparotomy was the procedure of choice and did not discourage Eileen from this type of surgery despite the risk of complications. He did not offer her a second opinion. No prior medical conditions pertinent to this surgery were present. With the exception of symptoms of urgency and a visually prolapsed uterus, Eileen had no other medical problems. She was active in her church and community as well as taking care of her spouse.
Postoperative course initially was normal until discharge when she started to vomit bile and was readmitted 18 hours post discharge. The surgeon evaluated Eileen and suspected she developed a postoperative ileus. His initial treatment consisted of telling her daughter to " give her a milkshake" to encourage her bowel to move. She did indeed follow the surgeon's advice; however, Eileen’s condition continued to deteriorate. Conservative treatment over the following two weeks consisted of clear liquids and nothing by mouth. Total parenteral nutrition {TPN} was then initiated and finally bowel decompression via nasogastric tube. Preliminary x-rays were done but results were not followed up on.

At two weeks postop a computed tomography {CT} scan was done which revealed a blockage in the small bowel. The surgeon advised Eileen of the need to return to surgery because he suspected that an adhesion was causing the blockage and it needed to be released. Eileen consented to the surgery and requested that her previous surgeon {bowel cancer} be in attendance. The current surgeon said he was out of town and he was asking another colorectal surgeon to be on hand.

Eileen was taken to surgery May 17, 2001. After 5.5 hrs of surgery the surgeon informed her daughter that he found a portion of the small bowel had twisted and he had to resect a portion of it. Because there were enterotomies, a jejunostomy was placed along with two mucous fistuals. Blood loss required transfusion of six units of blood during surgery. Eileen was transferred to the surgical intensive care where she required full fluid resuscitation and mechanical ventilation for two weeks. She sustained atrial fibrillation, required seventeen units of blood and clotting factors secondary to developing large retroperitonal hematoma. She remained in the ICU for 4 weeks and transferred to the floor for two more weeks at which time she was admitted to a long term acute care hospital. Before discharge the resident informed her that she had a rectal laceration and would need to have that repaired when her jejunostomy would be reversed in one year. She remained at the acute care hospital for 4 weeks then transferred to a nursing home to continue her recovery. Eileen was so debilitated from the surgery she required daily physical and occupational therapy.

During this entire time she experienced daily nausea and vomiting. Physicians at two different hospitals were consulted and determined that gallstones in the common bile duct were causing her symptoms along with elevated liver function. Eileen underwent repeated endoscopic retrograde cholangio pancreatopography {ERCP} over the next several months as no surgeon would remove her gallbladder for risk of causing more bleeding and complications.

Eileen had two episodes of sepsis treated by antibiotics during several readmits to the original surgical facility.

Finally in December of 2002, she became acutely septic and unresponsive and was transferred to the emergency room of a nearby hospital. The hospital surgeon determined that removing her gallbladder was probably her only chance to survive. She was placed on full life support, aggressive antibiotic management, vasopressor agents and taken to surgery. The surgeon successfully removed the gallbladder and informed the family that her organs were stuck together like cement. He gave no guarantees but stated that with antibiotics and life support she may be able to survive but with an arduous recovery. The bilirubin continued to rise; she was severely jaundiced and no longer responded to increase vasopressors or dialysis. Eileen Bialek expired on January 8, 2002. The postmortem documents indicated that she died of organ failure secondary to sepsis. The origin of the infection was vancomycin resistant enterococci {VRE} in the common bile duct probably secondary to the ERCP or the residual retroperitoneal hematoma.

I believe she was deceived by her surgeon in terms of the full disclosure of the risks involved in this kind of surgery. Anyone who knew her would testify that she was not one to take un-necessary risks. Accordingly, I am asking Congress to pass "Do No Harm" legislation requiring a neutral third party to be present during all pre-surgical consultations.

While I'm sorry for the loss of your mother, I think the legislation you are suggesting is unnecessary.

It was not the surgeon's job to "provide" a second opinion, it is the patient's perogative to seek one. That your mother didn't seek a second opinion was her own fault.

Whether or not there was any malpractice involved is not something we here are qualified to determine. It's not even clear if everything that occurred after teh surgery is a direct result of that surgery, or just that your mother had a complicated medical history and just had an unfortunate series of illnesses, perhaps exacerbated by her initial surgery for colon cancers and the resulting adhesions. Considering your mother did have previous surgeries that presented risks of complications, whether or not this surgery was necessary and whether there was any better option for her is something only another physician could determine, which is of course why patients should seek second opinions prior to undergoing major procedures (or anything that seems serious enough to them to be reason for concern).

Who would expect this third party to be anyway? How would they be more or less neutral than the physician you're already seeing? And what good would having them present do? A second opinion is far more valuable if you seek it from someone entirely independent of the physician you are already seeing, in other words, don't go see their golfing buddy they recommend to you, go find someone else on your own.

A medical ombudsman could serve as a checks and balance between doctor and patient. Today, companies record conversations between company and customer. Had the surgeon advised my mother that one of the potential risks was a jejunostomy, she would not have had it done.

Staff: Mentor

JOEBIALEK said:

A medical ombudsman could serve as a checks and balance between doctor and patient. Today, companies record conversations between company and customer. Had the surgeon advised my mother that one of the potential risks was a jejunostomy, she would not have had it done.

I don't think it would be normal for a surgeon to advise of a potential need for a jejunostomy as a result of the procedure she was having.

I don't think a third party is necessary because most insurance companies allow second opinions, some insist on it for a large number of procedures, or they may have an internal review board.

A medical ombudsman could serve as a checks and balance between doctor and patient. Today, companies record conversations between company and customer. Had the surgeon advised my mother that one of the potential risks was a jejunostomy, she would not have had it done.

So, rather than encourage people to seek a second opinion from another qualified surgeon, which, as Evo mentioned, is covered and encouraged by most insurance companies, you'd rather have a non-medical third party present during your discussions with your surgeon to try to second-guess them? This sounds like you want medical decisions made by lawyers instead of doctors. This sounds like something that could cause more harm than good, especially when it comes to getting insurance companies to cover second opinions. And, if you make it mandatory, what about the patient's rights to privacy? Personally, I wouldn't want some lawyer type present when I'm discussing my medical conditions with my physician. It would serve to undermine doctor-patient confidentiality and the doctor-patient relationship.

Seeking a completely independent second opinion is a much better way to go.

Not only do I disagree with your suggestion Joebialek, I find it morally wrong. Because our society relies on healthcare systems (unfortunately), we cannot afford to spend vast quantities of money so 72 year old people are forced to get a second opinion.

They can either get a second opinion on their own perogative, or they can risk getting only one.

Actually when someone has had a history of extensive abdominal surgery, open abdominal surgery is probably more prudent.

In her case, she had a history of previous cancer....., there is nothing like an open approach to visualize for reooccurance of the original cancer (something all surgeons are always on the look out for.) while they are in there fixing another organ problem.

It's amazing how many times elective abdominal surgeries pick up cancers that otherwise would have gone unnoticed or undetected even with abdominal CAT scans.

Secondly, adhesions left by prior surgeries and residual organ displacement can make laproscopic approach (surgeries done with small incisions and visualized with a scope) much more difficult and dangerous. Same holds true for vaginal approaches since the field of view is much more limited and you may tug or cut something that wasn't supposed to be there but ended up there due to the previous surgery. (Doing vaginal hysterectomies or uterine slings etc. is equivalent to doing surgery through a toilet paper roll (that is your field of vision and operative room to manuver the instruments.)

I am very sorry for her very complicated medical course after the surgery.